A 43-year-old male presents with eye pain after exposure to fertilizer and lime. Which is the most appropriate initial step in managing this patient's symptoms?

• A. Double evert his eyelids to look for remaining foreign bodies
• B. Fluorescein stain his eye
• C. Instill proparacaine 0.5% ophthalmic solution
• D. Irrigate his eye until the pH is between 6.8 and 7.4

Answer: (C)

The key idea is to control pain quickly so you can safely assess and treat the eye after a chemical exposure. Fertilizer and lime are alkaline agents that can cause rapid ocular surface injury, so rapid pain relief helps the patient keep the eye open and reduces reflex rubbing that can worsen damage. Instilling a topical anesthetic such as proparacaine provides immediate analgesia, making it possible to perform a careful examination and proceed with essential steps like irrigation and assessment of the ocular surface. After numbing the eye, you would typically irrigate to remove the chemical and restore a neutral surface pH, then continue with staining to evaluate for corneal injury and determine further treatment. While irrigation and pH normalization are crucial, giving analgesia first facilitates a safer and more thorough initial evaluation and management.